Risk factors for diastolic left ventricular myocardial dysfunction in patients with chronic kidney disease


Cite item

Full Text

Abstract

Purpose of the study. To examine the frequency and risk factors for the development of diastolic dysfunction (DD) of the left ventricle (LV) of the heart in patients with chronic kidney disease (CKD). Materials and methods. The study included 225 patients with stage I-CKD of non-diabetic etiology (median age 47.0 years, 50.2% of women). Depending on the degree of decrease in the glomerular filtration rate (GFR), all patients were divided into 3 groups. Group 1 (n=70) consisted of patients with GFR 89-45 ml / min / 1.73 m2, group 2 (n=120) - patients with GFR 44-15 ml / min / 1.73 m2, group 3 (n=35) - patients with GFR <15 mL / min / 1.73 m2. The control group includes persons without CKD. All patients underwent general clinical examination and transthoracic echocardiography; in 86 patients the level of cystatin C in the blood serum was determined. Results. Hypertrophy of the left ventricle (LVH) of the heart was detected in 87 (38.7%) of 225 patients with CKD. Hypertrophic type (type I) of myocardial DD is diagnosed in 90 (41.4%) of 225 patients with CKD. The incidence of myocardial left ventricular dysfunction of the 1st type increased with a decrease in GFR, amounting to 30, 40 and 60% in groups 1, 2 and 3, respectively. The systolic function of the left ventricular myocardium was preserved. Patients with DD were older, they had a higher body mass index (BMI), a more pronounced decrease in GFR, a higher level of fibrinogen. They were more likely to have LVH. The level of cystatin C as the kidney function worsened, but when comparing the mean levels of cystatin C in patients with the presence / absence of DD in the groups isolated depending on the stage of CKD, no statistically significant differences were found. According to the multivariate analysis, the independent predictor of DD was the age (odds ratio 1.106, 95% confidence interval 1.051-1.157, p=0.00001). The conclusion. DD of the myocardium of the LV is detected on average in 40% of patients with CKD, the frequency of its development increases with the progression of renal dysfunction. The development of DD is influenced by traditional factors of cardiovascular risk (age, BMI), as well as the decline in GFR and closely related structural remodeling of LV myocardium.

About the authors

T E Rudenko

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: atatianaer@yandex.ru
к.м.н., ассистент каф. внутренних, профессиональных болезней и пульмонологии медико-профилактического факультета Moscow, Russia

E S Kamyshova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

к.м.н., ассистент каф. внутренних, профессиональных болезней и пульмонологии медико-профилактического факультета Moscow, Russia

M P Vasilyeva

I.M. Sechenov First Moscow State Medical University (Sechenov University)

к.м.н., врач-нефролог отд-ния «Искусственная почка» клиники нефрологии, внутренних и профессиональных болезней им. Е.М. Тареева Университетской клинической больницы №3 Moscow, Russia

I N Bobkova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

д.м.н., проф., каф. внутренних, профессиональных болезней и пульмонологии медико-профилактического факультета Moscow, Russia

N I Solomakhina

I.M. Sechenov First Moscow State Medical University (Sechenov University)

д.м.н., проф., каф. госпитальной терапии №1 лечебного факультета Moscow, Russia

M Yu Shvetsov

I.M. Sechenov First Moscow State Medical University (Sechenov University); M.V. Lomonosov Moscow State University, Faculty of Fundamental Medicine

к.м.н., доцент, каф. внутренних, профессиональных болезней и пульмонологии медико-профилактического факультета Первого МГМУ им. И.М. Сеченова (Сеченовский университет); доцент каф. внутренних болезней факультета фундаментальной медицины МГУ им. М.В. Ломоносова Moscow, Russia

References

  1. Мухин Н.А., Моисеев В.С. Кардиоренальные соотношения и риск сердечно - сосудистых заболеваний. Вестник РАМН. 2003;11:50-5
  2. Ronco C, Chionh C.Y, Haapio M, Anavekar N.S, House A, Bellomo R. The cardiorenal syndrome. Blood Purif. 2009;27(1):114-26. https://doi.org/ 10.1159/000167018
  3. Schiffrin E.L, Lipman M, Mann J.F.E. Chronic kidney disease. Effects on the cardiorenal system. Circulation. 2007;116(1):85-97. https://doi.org/10.1161/ CIRCULATIONAHA.106.678342
  4. Longhini C, Molino C, Fabbian F. Cardiorenal syndrome: still not a defined entity. Clinical and Experimental Nephrology. 2010;14(1):12-21.https://doi.org/10.1007/s10157-009-0257-4
  5. Мареев В.Ю., Фомин И.В., Агеев Ф.Т., Арутюнов Г.П., Беграмбекова Ю.Л., Беленков Ю.Н., Васюк Ю.А., Галявич А.С., Гарганеева А.А., Гендлин Г.Е., Гиляревский С.Р., Глезер М.Г., Драпкина О.М., Дупляков Д.В., Кобалава Ж.Д., Козиолова Н.А., Лопатин Ю.М., Мареев Ю.В., Моисеев В.С., Недошивин А.О., Перепеч Н.Б., Ситникова М.Ю., Скибицкий В.В., Тарловская Е.И., Чесникова А.И., Шляхто Е.В. Клинические рекомендации. Хроническая сердечная недостаточность (ХСН). Сердечная Недостаточность. 2017;18(1):3-40 https://doi.org/10.18087 /rhfj.2017.1.2346
  6. Harnett J.D, Foley R.N, Kent G.M, Barre E, Murray D, Parfrey P. Congestive heart failure in dialysis patients: prevalence, incidence, prognosis, and risk factors. Kidney Int. 1995;47:884-90. https://doi.org/ 10.1038/ki.1995.132
  7. Bhatia R.S, Tu J.V, Lee D.S, Austin P.C, Fang J, Haouzi A, Gong Y, Liu P.P. Outcome of heart failure with preserved ejection fraction in a population - based study. N Engl J Med. 2006;355:260-69. https://doi.org/10.1056/ NEJMoa051530
  8. Herget-Rosenthal S, Bökenkam A, Hofmann W. How to estimate GFR-serum creatinine, serum cystatin C or equations? Clin Biochem. 2007;40(3-4):153-61. https://doi.org/10.1016/j.clinbiochem.2006. 10.014
  9. Каюков И.Г., Смирнов А.В., Эмануэль В.Л. Цистатин С в современной медицине. Нефрология. 2012;16(1):22-39
  10. Moran A, Katz R, Smith N.L, Fried L, Sarnak M, Seliger S, Psaty B, Siscovick D, Gottdiener J, Shlipak M. Cystatin C concentration as a predictor of systolic and diastolic heart failure. J Card Fail. 2008;14:19-26. https://doi.org/10.1016/j.cardfail.2007.09.002
  11. Ix J.H, Shlipak M.G, Chertow G.M, Ali S, Schiller N, Whooley M. Cystatin C, Left Ventricular Hypertrophy, and Diastolic Dysfunction: Data From the Heart and Soul Study. J Card Fail. 2006; 12(8):601-07. https://doi.org/10.1016/j.cardfail.2006.07.005
  12. Швецов М.Ю. Хроническая болезнь почек как общемедицинская проблема: современные принципы нефропрофилактики и нефропротекции. Consilium Medicum. 2014;17(7):51-64
  13. Stevens P, Levin A. Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice Guideline. Ann Intern Med. 2013;158(11):825-31. https://doi.org/1010.7326/0003-4819-158-11-201306040-00007
  14. Sidmal P.S, Mallikarjun H.P, Shekarappa K.C. Pattern and severity of left ventricular diastolic dysfunction in early and end stage renal disease patients with or without dialysis in rural population in South India. International J Biomed Res. 2015;6(08):546-53. https://doi.org/ 10.7439/ijbr
  15. Farshid A, Pathak R, Shadbolt B, Arnolda L, Talaulikar G. Diastolic function is a strong predictor of mortality in patients with chronic kidney disease. BMC Nephrology. 2013;14:280. http://dx.doi.org/10. 1186/1471-2369-14-280
  16. Шутов А.М., Куликова Е.С., Ивашкина Т.Н., Кондратьева Н.И. Анемия и диастолическая функция левого желудочка у больных с додиализной хронической почечной недостаточностью. Нефрология и диализ. 2001;3(4):422-26
  17. Park M, Hsu C-y, Li Y, Mishra R.K, Keane M, Rosas S.E, Dries D, Xie D, Chen J, He J, Anderson A, Go A, Shlipak M.G. Associations between kidney function and subclinical cardiac abnormalities in CKD. J Am Soc Nephrol. 2012;23:1725-34. http://dx.doi.org/10.1681/ ASN. 2012020145
  18. Elloual F, Berkch F, Bayahia R, Benamar L, Cherti M. Comparison of the Effects of Dialysis Methods (Haemodialysis vs Peritoneal Dialysis) on Diastolic Left Ventricular Function Dialysis Methods and Diastolic Function. Open Cardiovasc Med J. 2016;10:171-78. http://dx.doi.org/ 10.2174/1874192401610010171
  19. Hayashi S.Y, Rohani M, Lindholm B, Brodin L-A, Lind B, Barany P, Alvestrand F, Seeberger A. Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging. Nephrol Dial Transplant. 2006;21:125-32. http://dx.doi.org 10.1093/ndt/gfi075
  20. Losi M.A, Memoli B, Contaldi C, Barbati G, del Prete M, Betocchi S, Cavallaro M, Carpinella G, Fundaliotis A, Parrella L.S, Parisi L, Guida B, Chiariello M. Myocardial fibrosis and diastolic dysfunction in patients on chronic haemodialysis. Nephrol Dial Transplant. 2010;25(6):1950-4. http://dx.doi.org10.1093/ndt/gfp747
  21. Sarnak M.J, Coronado B.E, Greene T, et al. Cardiovascular disease risk factors in chronic renal insufficiency. Clin Nephrol. 2002;57:327-35.
  22. Кутырина И.М., Руденко Т.Е., Швецов М.Ю., Кушнир В.В. Факторы риска сердечно - сосудистых осложнений у больных на додиализной стадии хронической почечной недостаточности. Терапевтический архив. 2006;5:45-50
  23. Dervisoglu E, Kozdag G, Etiler N, Kalender B. Association of glomerular filtration rate and inflammation with left ventricular hypertrophy in chronic kidney disease patients. Hippokratia. 2012;16(2):137-42. PMID: 23935269. PMCID: PMC3738415
  24. Steptoe A, Kivimäki M, Lowe G, Rumley A, Hamer M. Blood Pressure and Fibrinogen Responses to Mental Stress as Predictors of Incident Hypertension over an 8-Year Period. Ann Behav Med. 2016;50:898-906. https://doi.org/10.1007/s12160-016-9817-5
  25. Catena C, Colussi G, Fedrizzi S, Sechi L.A. Association of a prothrombotic state with left - ventricular diastolic dysfunction in hypertension: a tissue-Doppler imaging study. J Hypertens. 2013;31(10):2077-84. https://doi.org/10.1097/HJH.0b013e328362d951
  26. Fassett R, Venuthurupalli S.K, Gobe G.G, Coombes J.S, Cooper M.A, Hoy W.E. Biomarkers in chronic kidney disease: a review. Kidney Int. 2011;80(8):806-21. http://dx.doi.org/10.1038/ki.2011.198
  27. Weiner D.E, Tighiouart H, Elsayed E.F, Griffith J.L, Salem D.N, Levey A.S, Sarnak M.J. The relationship between nontraditional risk factors and outcomes in individuals with stage 3 to 4 CKD. Am J Kidney Dis. 2008;51(2):212-23. http://dx.doi.org/ 10.1053/j.ajkd.2007.10.035
  28. Agarwal S, Thohan V, Shlipak M.G, Lima J, Bluemke D, Siscovick D, Gomes A, Herrington D. Association between Cystatin C and MRI Measures of Left Ventricular Structure and Function: Multi-Ethnic Study of Atherosclerosis. Intern J Nephrology. 2011:1-7. https://doi.org/ 10.4061/2011/153868
  29. Patel P, Ayers C.R, Murphy S, Peshock R, Khera A, de Lemos J.A, Balko J.A, Gupta S, Mammen P.P.A, Drazner M.H, Markham D.W.Association of Cystatin C With Left Ventricular Structure and Function: The Dallas Heart Study. Circulation: Heart Fail. 2009;2:98-104. https://doi.org/10.1161/circheartfailure.108.807271
  30. Sakuragi S, Ichikawa K, Yamada K, Tanimoto M, Miki T, Otsuka H, Yamamoto K, Kawamoto K, Katayama Y, Tanakaya M, Ito H. Serum cystatin C level is associated with left atrial enlargement, left ventricular hypertrophy and impaired left ventricular relaxation in patients with stage 2 or 3 chronic kidney disease. Int J Cardiol. 2015;190:287-92. https://doi.org/10.1016/j.ijcard.2015.04.189
  31. Brady T.M, Townsend K, Schneider M.F, Cox C, Kimball T, Madueme P, Warady B, Furth S, Mitsnefes M. Cystatin C and Cardiac Measures in Children and Adolescents With CKD. Am J Kidney Dis. 2017;6(2):247-56. https://doi.org/10.1053/j.ajkd.2016.08.036
  32. Djoussé L, Kurth T, Gaziano M.J. Cystatin C and Risk of Heart Failure in the Physicians’ Health Study. Am Heart J. 2008;155(1):82-6. https://doi.org/ 10.1016/j.ahj.2007.08.023
  33. Taglieri1 N, Koenig W, Kaski J.C. Cystatin C and Cardiovascular Risk. Clinical Chemistry. 2009;55(11):1932-43. https://doi.org/10.1373/ clinchem.2009.128397
  34. Shlipak M.G, Katz R, Cushman M, Sarnak M.J, Stehman-Breen C, Psaty B.M, Siscovick D, Tracy R.P, Newman A, Fried L. Cystatin-C and inflammatory markers in the ambulatory elderly. Am J Med. 2005;118:1416.e25-1416.e31. https://doi.org/10.1016/j.amjmed.2005. 07.060
  35. Singh D, Whooley M.A, Ix J.H, Ali S, Shlipak M.G. Association of cystatin C and estimated GFR with inflammatory biomarkers: Heart and Soul Study. Nephrol Dial Transplant. 2007;22:1087-92. https://doi.org/ 10.1093/ndt/gfl744.
  36. Xie L, Terrand J, Xu B, Tsaprailis G, Boyer J, Chen Q.M. Cystatin C increases in cardiac injury: a role in extracellular matrix protein modulation. Cardiovasc Res. 2010;87:628-35. https://doi.org/ 10.1093/cvr/ cvq138
  37. Козловская Л.В., Бобкова И.Н., Варшавский В.А., Проскурнева Е.П., Мирошниченко Н.Г., Чеботарева Н.В., Мухин Н.А. Фибронектин мочи как показатель процессов фиброзирования в почке при нефрите. Терапевтический архив. 1997;6:34-8

Copyright (c) 2018 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies